tbuckley/cabot-search huggingface dataset:
Use of High-Risk Medications Among Older Adults Enrolled in Medicare Advantage Plans vs Traditional Medicare
Authors: Jose F. Figueroa, Dannie Dai, Yevgeniy Feyman, Melissa M. Garrido, Thomas C. Tsai, E. John Orav, Austin B. Frakt
Journal: JAMA Network Open (2023)

Importance Limiting the use of high-risk medications (HRMs) among older adults is a national priority to provide a high quality of care for older beneficiaries of both Medicare Advantage and traditional fee-for-service Medicare Part D plans. Objective To evaluate the differences in the rate of HRM prescription fills among beneficiaries of traditional Medicare vs Medicare Advantage Part D plans and to examine the extent to which these differences change over time and the patient-level factors associated with higher rates of HRMs. Design, Setting, and Participants This cohort study used a 20% sample of Medicare Part D data on filled drug prescriptions from 2013 to 2017 and a 40% sample from 2018. The sample comprised Medicare beneficiaries aged 66 years or older who were enrolled in Medicare Advantage or traditional Medicare Part D plans. Data were analyzed between April 1, 2022, and April 15, 2023. Main Outcomes and Measures The primary outcome was the number of unique HRMs prescribed to older Medicare beneficiaries per 1000 beneficiaries. Linear regression models were used to model the primary outcome, adjusting for patient characteristics and county characteristics and including hospital referral region fixed effects. Results The sample included 5 595 361 unique Medicare Advantage beneficiaries who were propensity score–matched on a year-by-year basis to 6 578 126 unique traditional Medicare beneficiaries between 2013 and 2018, resulting in 13 704 348 matched pairs of beneficiary-years. The traditional Medicare vs Medicare Advantage cohorts were similar in age (mean [SD] age, 75.65 [7.53] years vs 75.60 [7.38] years), proportion of males (8 127 261 [59.3%] vs 8 137 834 [59.4%]; standardized mean difference [SMD] = 0.002), and predominant race and ethnicity (77.1% vs 77.4% non-Hispanic White; SMD = 0.05). On average in 2013, Medicare Advantage beneficiaries filled 135.1 (95% CI, 128.4-142.6) unique HRMs per 1000 beneficiaries compared with 165.6 (95% CI, 158.1-172.3) HRMs per 1000 beneficiaries for traditional Medicare. In 2018, the rate of HRMs had decreased to 41.5 (95% CI, 38.2-44.2) HRMs per 1000 beneficiaries in Medicare Advantage and to 56.9 (95% CI, 54.1-60.1) HRMs per 1000 beneficiaries in traditional Medicare. Across the study period, Medicare Advantage beneficiaries received 24.3 (95% CI, 20.2-28.3) fewer HRMs per 1000 beneficiaries per year compared with traditional Medicare beneficiaries. Female, American Indian or Alaska Native, and White populations were more likely to receive HRMs than other groups. Conclusion and Relevance Results of this study showed that HRM rates were consistently lower among Medicare Advantage than traditional Medicare beneficiaries. Higher use of HRMs among female, American Indian or Alaska Native, and White populations is a concerning disparity that requires further attention.
Transgender Identity and Suicide Attempts and Mortality in Denmark
Authors: Annette Erlangsen, Anna Lund Jacobsen, Anne Ranning, Alex Lauridsen Delamare, Merete Nordentoft, Morten Frisch
Journal: JAMA (2023)

Prior studies have suggested that transgender individuals may be a high-risk group with respect to suicide attempt and mortality, but large-scale, population-based investigations are lacking.To examine in a national setting whether transgender individuals have higher rates of suicide attempt and mortality than nontransgender individuals.Nationwide, register-based, retrospective cohort study on all 6 657 456 Danish-born individuals aged 15 years or older who lived in Denmark between January 1, 1980, and December 31, 2021.Transgender identity was determined through national hospital records and administrative records of legal change of gender.Suicide attempts, suicide deaths, nonsuicidal deaths, and deaths by any cause during 1980 through 2021 were identified in national hospitalization and causes of death registers. Adjusted incidence rate ratios (aIRRs) with 95% CIs controlling for calendar period, sex assigned at birth, and age were calculated.The 6 657 456 study participants (50.0% assigned male sex at birth) were followed up during 171 023 873 person-years. Overall, 3759 individuals (0.06%; 52.5% assigned male sex at birth) were identified as transgender at a median age of 22 years (IQR, 18-31 years) and followed up during 21 404 person-years, during which 92 suicide attempts, 12 suicides, and 245 suicide-unrelated deaths occurred. Standardized suicide attempt rates per 100 000 person-years were 498 for transgender vs 71 for nontransgender individuals (aIRR, 7.7; 95% CI, 5.9-10.2). Standardized suicide mortality rates per 100 000 person-years were 75 for transgender vs 21 for nontransgender individuals (aIRR, 3.5; 95% CI, 2.0-6.3). Standardized suicide-unrelated mortality rates per 100 000 person-years were 2380 for transgender vs 1310 for nontransgender individuals (aIRR, 1.9; 95% CI, 1.6-2.2), and standardized all-cause mortality rates per 100 000 person-years were 2559 for transgender vs 1331 for nontransgender individuals (aIRR, 2.0; 95% CI, 1.7-2.4). Despite declining rates of suicide attempts and mortality during the 42 years covered, aIRRs remained significantly elevated in recent calendar periods up to and including 2021 for suicide attempts (aIRR, 6.6; 95% CI, 4.5-9.5), suicide mortality (aIRR, 2.8; 95% CI, 1.3-5.9), suicide-unrelated mortality (aIRR, 1.7; 95% CI, 1.5-2.1), and all-cause mortality (aIRR, 1.7; 95% CI, 1.4-2.1).In this Danish population-based, retrospective cohort study, results suggest that transgender individuals had significantly higher rates of suicide attempt, suicide mortality, suicide-unrelated mortality, and all-cause mortality compared with the nontransgender population.
Venous thromboembolism mortality and trends in older US adults, 2011–2019
Authors: Katherine Giorgio, Rob F. Walker, Richard F. MacLehose, Diego Adrianzen‐Herrera, Wendy Wang, Alvaro Alonso, Neil A. Zakai, Pamela L. Lutsey
Journal: American Journal of Hematology (2023)

Venous thromboembolism (VTE) affects 1.2 million people per year in the United States. With several clinical changes in diagnosis and treatment approaches in the past decade, we evaluated contemporary post-VTE mortality risk profiles and trends. Incident VTE cases were identified from the 2011-2019 Medicare 20% Sample, which is representative of nearly all Americans aged 65 and older. The social deprivation index was linked from public data; race/ethnicity and sex were self-reported. The all-cause mortality risk 30 days and 1 year after incident VTE was calculated in demographic subgroups and by prevalent cancer diagnosis status using model-based standardization. Risks for major cancer types, risk differences by age, sex, race/ethnicity, and socio-economic status (SES), and trends over time are also reported. The all-cause mortality risk among older US adults following incident VTE was 3.1% (95% CI 3.0-3.2) at 30 days and 19.6% (95% CI 19.2-20.1) at 1 year. For cancer-related VTE events, the age-sex-race-standardized risk was 6.0% at 30 days and 34.7% at 1 year. The standardized 30-day and 1-year risks were higher among non-White beneficiaries and among those with low SES. One-year mortality risk decreased 0.28 percentage points per year (95% CI 0.16-0.40) on average across the study period, with no trend observed for 30-day mortality risk. In sum, all-cause mortality risk following incident VTE has decreased slightly in the last decade, but racial and socio-economic disparities persist. Understanding patterns of mortality among demographic subgroups and in cancer-associated events is important for targeting efforts to improve VTE management.
Birtamimab plus standard of care in light-chain amyloidosis: the phase 3 randomized placebo-controlled VITAL trial
Authors: Morie A. Gertz, Adam D. Cohen, Raymond L. Comenzo, Efstathios Kastritis, Heather J. Landau, Edward N. Libby, Michaela Liedtke, Vaishali Sanchorawala, Stefan Schönland, Ashutosh Wechalekar, Jeffrey A. Zonder, Giovanni Palladini, Jackie Walling, Spencer Guthrie, Christie Nie, Carol Karp, Yuying Jin, Gene G. Kinney, Giampaolo Merlini
Journal: Blood (2023)

Abstract Amyloid light-chain (AL) amyloidosis is a rare, typically fatal disease characterized by the accumulation of misfolded immunoglobulin light chains (LCs). Birtamimab is an investigational humanized monoclonal antibody designed to neutralize toxic LC aggregates and deplete insoluble organ-deposited amyloid via macrophage-induced phagocytosis. VITAL was a phase 3 randomized, double-blind, placebo-controlled clinical trial assessing the efficacy and safety of birtamimab + standard of care (SOC) in 260 newly diagnosed, treatment-naive patients with AL amyloidosis. Patients received 24 mg/kg IV birtamimab + SOC or placebo + SOC every 28 days. The primary composite end point was the time to all-cause mortality (ACM) or centrally adjudicated cardiac hospitalization ≥91 days after the first study drug infusion. The trial was terminated early after an interim futility analysis; there was no significant difference in the primary composite end point (hazard ratio [HR], 0.826; 95% confidence interval [CI], 0.574-1.189; log-rank P = .303). A post hoc analysis of patients with Mayo stage IV AL amyloidosis, those at the highest risk of early mortality, showed significant improvement in the time to ACM with birtamimab at month 9 (HR, 0.413; 95% CI, 0.191-0.895; log-rank P = .021). At month 9, 74% of patients with Mayo stage IV AL amyloidosis treated with birtamimab and 49% of those given placebo survived. Overall, the rates of treatment-emergent adverse events (TEAEs) and serious TEAEs were generally similar between treatment arms. A confirmatory phase 3 randomized, double-blind, placebo-controlled clinical trial of birtamimab in patients with Mayo stage IV AL amyloidosis (AFFIRM-AL; NCT04973137) is currently enrolling. The VITAL trial was registered at www.clinicaltrials.gov as #NCT02312206.
Exposure to Agent Orange and Risk of Bladder Cancer Among US Veterans
Authors: Stephen B. Williams, Jessica L. Janes, Lauren E. Howard, Ruixin Yang, Amanda M. De Hoedt, Jacques G. Baillargeon, Yong-Fang Kuo, Douglas S. Tyler, Martha K. Terris, Stephen J. Freedland
Journal: JAMA Network Open (2023)

Importance To date, limited data exist regarding the association between Agent Orange and bladder cancer, and the Institute of Medicine concluded that the association between exposure to Agent Orange and bladder cancer outcomes is an area of needed research. Objective To examine the association between bladder cancer risk and exposure to Agent Orange among male Vietnam veterans. Design, Setting, and Participants This nationwide Veterans Affairs (VA) retrospective cohort study assesses the association between exposure to Agent Orange and bladder cancer risk among 2 517 926 male Vietnam veterans treated in the VA Health System nationwide from January 1, 2001, to December 31, 2019. Statistical analysis was performed from December 14, 2021, to May 3, 2023. Exposure Agent Orange. Main Outcomes and Measures Veterans exposed to Agent Orange were matched in a 1:3 ratio to unexposed veterans on age, race and ethnicity, military branch, and year of service entry. Risk of bladder cancer was measured by incidence. Aggressiveness of bladder cancer was measured by muscle-invasion status using natural language processing. Results Among the 2 517 926 male veterans (median age at VA entry, 60.0 years [IQR, 56.0-64.0 years]) who met inclusion criteria, there were 629 907 veterans (25.0%) with Agent Orange exposure and 1 888 019 matched veterans (75.0%) without Agent Orange exposure. Agent Orange exposure was associated with a significantly increased risk of bladder cancer, although the association was very slight (hazard ratio [HR], 1.04; 95% CI, 1.02-1.06). When stratified by median age at VA entry, Agent Orange was not associated with bladder cancer risk among veterans older than the median age but was associated with increased bladder cancer risk among veterans younger than the median age (HR, 1.07; 95% CI, 1.04-1.10). Among veterans with a diagnosis of bladder cancer, Agent Orange was associated with lower odds of muscle-invasive bladder cancer (odds ratio [OR], 0.91; 95% CI, 0.85-0.98). Conclusions and Relevance In this cohort study among male Vietnam veterans, there was a modestly increased risk of bladder cancer—but not aggressiveness of bladder cancer—among those exposed to Agent Orange. These findings suggest an association between Agent Orange exposure and bladder cancer, although the clinical relevance of this was unclear.
CD19-Targeting CAR T-Cell Therapy for Antisynthetase Syndrome
Authors: Ingrid E. Lundberg, Angeles S. Galindo-Feria, Begum Horuluoglu
Journal: JAMA (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Clinical Characteristics and Outcomes in Patients With Heart Failure: Are There Thresholds and Inflection Points in Left Ventricular Ejection Fraction and Thresholds Justifying a Clinical Classification?
Authors: Toru Kondo, Pooja Dewan, Inder S. Anand, Akshay S. Desai, Milton Packer, Michael R. Zile, Marc A. Pfeffer, Scott D. Solomon, William T. Abraham, Sanjiv J. Shah, Carolyn S.P. Lam, Pardeep S. Jhund, John J.V. McMurray
Journal: Circulation (2023)

Recent guidelines proposed a classification for heart failure (HF) on the basis of left ventricular ejection fraction (LVEF), although it remains unclear whether the divisions chosen were biologically rational. Using patients spanning the full range of LVEF, we examined whether there was evidence of LVEF thresholds in patient characteristics or inflection points in clinical outcomes.Using patient-level information, we created a merged dataset of 33 699 participants who had been enrolled in 6 randomized controlled HF trials including patients with reduced and preserved ejection fraction. The relationship between the incidence of all-cause death (and specific causes of death) and HF hospitalization, and LVEF, was evaluated using Poisson regression models.As LVEF increased, age, the proportion of women, body mass index, systolic blood pressure, and prevalence of atrial fibrillation and diabetes increased, whereas ischemic pathogenesis, estimated glomerular filtration rate, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) decreased. As LVEF increased >50%, age and the proportion of women continued to increase, and ischemic pathogenesis and NT-proBNP decreased, but other characteristics did not change meaningfully. The incidence of most clinical outcomes (except noncardiovascular death) decreased as LVEF increased, with a LVEF inflection point of around 50% for all-cause death and cardiovascular death, around 40% for pump failure death, and around 35% for HF hospitalization. Higher than those thresholds, there was little further decline in the incidence rate. There was no evidence of a J-shaped relationship between LVEF and death; no evidence of worse outcomes in patients with high-normal ("supranormal") LVEF. Similarly, in a subset of patients with echocardiographic data, there were no structural differences in patients with a high-normal LVEF suggestive of amyloidosis, and NT-proBNP levels were consistent with this conclusion.In patients with HF, there was a LVEF threshold of around 40% to 50% where the pattern of patient characteristics changed, and event rates began to increase compared with higher LVEF values. Our findings provide evidence to support current upper LVEF thresholds defining HF with mildly reduced ejection fraction on the basis of prognosis.URL: https://www.gov; Unique identifiers: NCT00634309, NCT00634400, NCT00634712, NCT00095238, NCT01035255, NCT00094302, NCT00853658, and NCT01920711.
A novel method for efficient closure of large mucosal defects using nylon loops combined with titanium clips after endoscopic submucosal dissection
Authors: Geng Qin, Qian-qian Wang, Chang Tan
Journal: Endoscopy (2023)

Endoscopic submucosal dissection (ESD) is an effective treatment for early-stage gastrointestinal cancer [1] [2]. However, difficult site lesions (e. g., colon flexion, right-side colon) and large mucosal defects (greater than 5 cm) result in post-ESD defect closures as an ongoing challenge in clinical practice [3]. Therefore, we report a novel method for the efficient closure of large mucosal defects after ESD using nylon loops combined with titanium clips.
Low-pressure endoscopy using the gel immersion method facilitates endoscopic reduction of a Morgagni hernia
Authors: Keitaro Yano, Tomonori Yano, Alan Kawarai Lefor, Tetsuya Yano, Rei Aono, Hiroshi Sakaeda, Mitsuo Okada
Journal: Endoscopy (2023)

A Morgagni hernia is an uncommon diaphragmatic hernia. Complications such as obstruction and resulting necrosis can be life-threatening, and surgery is mandatory. However, minimally invasive treatments are preferred for elderly patients with comorbidities. Although treatment of a Morgagni hernia by endoscopic reduction has been reported [1], hyperinflation during colonoscopy may increase intraluminal pressure and exacerbate incarceration. In the presence of an incarcerated Morgagni hernia, bowel preparation for colonoscopy is impossible, and securing the visual field is difficult. Gel immersion endoscopy has been reported to be useful for securing the visual field and decreasing intraluminal pressure [2] [3].
Gel immersion echoendoscope-guided puncture before radial incision and cutting for complete rectal anastomotic obstruction
Authors: Shozo Osera, Takeshi Hisa, Gaku Akiyama, Akiharu Kudo, Takahiro Yamada, Hideki Fukushima, Akihisa Tomori
Journal: Endoscopy (2023)

Benign anastomotic complete obstruction rarely occurs after lower rectal cancer surgery [1]. The radial incision and cutting (RIC) method has been reported for complete rectal anastomotic obstruction [2]; however, it is important to penetrate the distal and proximal sides of the intestinal tract safely and accurately before RIC. A forward-viewing echoendoscope is useful for recanalizing postoperative biliary anastomotic atresia in endosonography-guided biliary drainage because it allows a more vertical approach and shortens the puncture distance [3] [4]. Furthermore, gel-immersion techniques have been reported for endoscopic procedures [5].
Successful treatment of obscure gastrointestinal bleeding with intraoperative enteroscopy
Authors: Mohamed G. Shiha, Foong Way David Tai, Hey-Long Ching, Arun Loganathan, David S. Sanders
Journal: Endoscopy (2023)

A 51-year-old man was referred to our institution with persistent iron deficiency anemia. Initial gastroduodenoscopy and colonoscopy at his local hospital were unremarkable. A subsequent small bowel capsule endoscopy revealed a distal small bowel polyp with evidence of fresh bleeding ([Fig. 1]). A triple-phase abdominal computed tomography scan confirmed a 13-mm vascular polypoid lesion within the distal small bowel, with hyperenhancement on the arterial phase ([Fig. 2]). After a discussion in a multidisciplinary team meeting, it was decided that surgical resection guided by intraoperative enteroscopy to localize the lesion would be the most appropriate course of action.
Convergence of endobariatrics and endohepatology for evaluation and treatment of obesity and nonalcoholic fatty liver disease
Authors: Arunkumar Krishnan, Sardar Momin Shah-Khan, Yousaf Hadi, Shyam Thakkar, Shailendra Singh
Journal: Endoscopy (2023)

Endohepatology is an emerging field that utilizes diagnostic and therapeutic endoscopic ultrasound (EUS) to manage liver disease. In recent years, endoscopic sleeve gastroplasty (ESG) has emerged as a safe and effective approach to treating obesity and nonalcoholic fatty liver disease (NAFLD) [1]. We present a combined approach of endobariatrics and endohepatology with the concept of a "one-stop shop" to evaluate portal hypertension, obesity, and associated NAFLD treatment.
“Hunting” for the pseudoaneurysm in a vascular maze: Endoscopic ultrasound solving the puzzle
Authors: Jayanta Samanta, Jahnvi Dhar, Uday Kiran Mangipudi, Bikkina Venkat Siddharda, Pankaj Gupta, Vikas Gupta
Journal: Endoscopy (2023)

A 43-year-old man with chronic calcific pancreatitis presented with melena for 15 days. He received four units of a packed red blood cell transfusion before presenting at our center. On evaluation, investigations revealed anemia (hemoglobin 5.6 gm/dl) with tachycardia. After initial resuscitation, the patient was taken for esophagogastroduodenoscopy, which revealed no gastric or duodenal varices or any non-variceal source of bleeding. Computed tomography angiography (CTA) [arterial phase] revealed a contrast-filled bi-lobed outpouching from the gastroduodenal artery (GDA) suggestive of a pseudoaneurysm (size 1 × 1.2 cm) ([Fig. 1]). On the venous phase, the portal vein was partially thrombosed with multiple collaterals surrounding the pseudoaneurysm ([Fig. 2]).
Peroral endoscopic myotomy to treat epiphrenic diverticulum: a step-by-step video demonstration
Authors: Apostolis Papaefthymiou, Benjamin Norton, Andrea Telese, Nasar Aslam, Vinay Sehgal, Rehan Haidry
Journal: Endoscopy (2023)

Epiphrenic diverticula represent an uncommon cause of dysphagia. Surgical diverticulectomy with myotomy has been the standard therapeutic approach, providing a high rate of short- and long-term improvement, albeit with a high morbidity rate [1].
Two-channel endoscope re-intervention for stent dysfunction after interventional endoscopic ultrasonography: forceps stabilization of stent for cutting by argon plasma coagulation
Authors: Haruka Toyonaga, Masayo Motoya, Tsuyoshi Hayashi, Toshifumi Kin, Kuniyuki Takahashi, Akio Katanuma
Journal: Endoscopy (2023)

As interventional endoscopic ultrasonography (EUS) has become widely performed, occasions for re-intervention because of stent dysfunction are increasing and several re-intervention methods have been reported [1] [2] [3] [4] [5]. We introduce here a novel technique utilizing a two-channel endoscope (GIF-2TQ260M; Olympus, Japan), in which a forceps is used to hold a stent in the required position whilst it is trimmed using argon plasma coagulation (APC) ([Fig. 1]).